Une analyse des écrits sur les impacts du jeu sur l’apprentissage

Cet article présente une synthèse des publications récentes (1998-2005) qui traitent des impacts du jeu, en tant que formule pédagogique, sur l’apprentissage. Constatant une grande variété d’approches, une certaine disparité dans la manière de présenter et d’interpréter les résultats, et souhaitant vérifier si les jeux éducatifs ont un impact réel sur l’apprentissage, les auteurs ont procédé à une recension des écrits sur le sujet à partir d’une grille d’analyse validée. Ces impacts sont détaillés après un résumé des attributs essentiels du jeu, attributs sur lesquels cette recherche a été fondée pour être menée à bien. L’analyse des écrits montre que le jeu a des impacts positifs sur l’apprentissage.This article presents a synthesis of recent (1998-2005) publications on the impact of play, as a pedagogical technique, on learning. While confirming that there are a great number of approaches, a certain disparity in the way of presenting and interpreting results, and hoping to verify if educational games have a real impact on learning, the authors used a validated analysis grid to produce a review of the literature in this area. The authors present a summary of the essential attributes of games, these attributes being used to frame this research, as well as details regarding the impacts noted. The analysis shows that play has positive impacts on learning.Este artículo presenta una síntesis de las publicaciones recientes (1998-2005) que tratan de los impactos del juego, como formula pedagógica, sobre el aprendizaje. Al observar una gran variedad de enfoques, una cierta disparidad en la manera de presentar y de interpretar los resultados, y con el deseo de comprobar si los juegos educativos tienen un real impacto sobre el aprendizaje, los autores procedieron a una recensión de los escritos sobre el tema a partir de una matriz de análisis validada. Estos impactos se detallan a continuación de un resumen de los atributos esenciales del juego, atributos que fundamentaron esta investigación para poder llevarla a cabo. El análisis de los escritos muestra que el juego tiene impactos positivos sobre el aprendizaje

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

mEYEstro software: an automatic tool for standardized refractive surgery outcomes reporting

Abstract Background Standardization for reporting medical outcomes enables clinical study comparisons and has a fundamental role in research reproducibility. In this context, we present mEYEstro, a free novel standalone application for automated standardized refractive surgery graphs. mEYEstro can be used for single and multiple group comparisons in corneal and intraocular refractive surgery patients. In less than 30 s and with minimal user manipulation, mEYEstro automatically creates the required journal standard graphs while simultaneously performing valid statistical analyses. Results The software produces the following 11 standard graphs; Efficacy: 1. Cumulative uncorrected (UDVA) and corrected visual acuity (CDVA), 2. Difference between UDVA and CDVA, Safety: 3. Change in line of CDVA, Accuracy: 4. Spherical equivalent (SEQ) to intended target, 5. Attempted vs. achieved SEQ, 6. Defocus equivalent (DEQ) accuracy, 7. Refractive astigmatism accuracy, 8. Target-induced astigmatism vs. Surgically-induced astigmatism, 9. Correction index histogram, 10. Angle of error histogram, Stability: 11. SEQ stability over time. Percent proportions, means, standard deviations, Cohen's d effect sizes, and p-values are calculated and displayed on each graph. All graphs can be easily exported as high-resolution TIFF images for figures to use in scientific manuscripts and presentations. Conclusions mEYEstro software enables clinicians, surgeons, and researchers, to easily and efficiently analyze refractive surgery outcomes using the standardized methodology required by several peer-reviewed ophthalmology journals

AstigMATIC: an automatic tool for standard astigmatism vector analysis

Abstract Background Standardization for reporting medical outcomes facilitates clinical study comparisons and has a fundamental role on research reproducibility. In this context, we present AstigMATIC, a free standalone application for automated standardized astigmatism vector analyses in corneal and intraocular refractive surgeries. AstigMATIC uses a simple graphical user interface (GUI) and allows the simultaneous display and analysis of astigmatism magnitude and axis. Results The software produces the four following standard graphs according to the standards of the Alpins Method; 1-Target-Induced Astigmatism Vector, 2-Surgically-Induced Astigmatism Vector, 3-Difference Vector and 4-Correction Index. Vector means with X and Y standard deviations are automatically calculated and displayed on the corresponding single-angle vector plots (0 to 180°). Data points are entered into a simplified GUI with no need for command line input. The standard graphs can be easily exported as high-resolution TIFF images for figures to use in production and presentations. Conclusions AstigMATIC software enables the user to easily and efficiently analyze vectorial astigmatism outcomes using the standardized Alpins Method for post-surgical astigmatism. AstigMATIC and the demonstration datasets are available to download from http://www.lasikmd.com/media/astigmatic

Effect of modified graphene oxide on the mechanical, thermal, and barrier properties of vinylester

Graphene, which is a one atom thick layer of graphite, has been considerably studied in the past decade due to its extraordinary physical properties. The development of new routes of synthesis facilitates the use of graphene in polymer nanocomposite. The addition of very small amounts (<1%) of graphene in a polymer matrix does not only increase its thermal and mechanical properties, but it would also enhance permeability, by limiting the diffusion of water through the material. Graphene-polymer nanocomposite would be an interesting alternative to conventional polymer nanocomposite such as nanoclay-polymer nanocomposite. In this study, graphene oxide is synthesized from graphite flakes, following the Tour method, and modified with silane to improve its compatibility with the polymer. Polymer nanocomposite made from vinylester resin and 0.5 wt% graphene oxide is prepared as well as other types of typically used polymer nanocomposite such as graphite flake, silica fume or nanoclay based composite. Samples are soaked in a water bath to study the water absorption of these nanocomposites. Mechanical property measurements and thermal analyses are performed to evaluate the benefit of using graphene oxide. Results show a significant enhancement of the mechanical and thermal properties with a graphene oxide content ten times lower than the one needed with conventional nanoparticles. Moreover, unlike nanoclay-based polymer nanocomposite, graphene oxide does not increase water absorption at saturation

Advance in ERG Analysis: From Peak Time and Amplitude to Frequency, Power, and Energy

Purpose. To compare time domain (TD: peak time and amplitude) analysis of the human photopic electroretinogram (ERG) with measures obtained in the frequency domain (Fourier analysis: FA) and in the time-frequency domain (continuous (CWT) and discrete (DWT) wavelet transforms). Methods. Normal ERGs n=40 were analyzed using traditional peak time and amplitude measurements of the a- and b-waves in the TD and descriptors extracted from FA, CWT, and DWT. Selected descriptors were also compared in their ability to monitor the long-term consequences of disease process. Results. Each method extracted relevant information but had distinct limitations (i.e., temporal and frequency resolutions). The DWT offered the best compromise by allowing us to extract more relevant descriptors of the ERG signal at the cost of lesser temporal and frequency resolutions. Follow-ups of disease progression were more prolonged with the DWT (max 29 years compared to 13 with TD). Conclusions. Standardized time domain analysis of retinal function should be complemented with advanced DWT descriptors of the ERG. This method should allow more sensitive/specific quantifications of ERG responses, facilitate follow-up of disease progression, and identify diagnostically significant changes of ERG waveforms that are not resolved when the analysis is only limited to time domain measurements

Thermal Stability of Cryomilled Al-Mg-Er Powders

In this study, the thermal stability of nanostructured Al-Mg alloy powders was investigated. Two alloy compositions, Al-5Mg-0.1Er and Al-5Mg-0.5Er (wt.%), were cryogenically milled for 30 h to produce nanostructured powders. The microstructure of the milled powders with increasing temperature was investigated by differential scanning calorimetry (DSC) with one-hour annealing performed at selected temperatures followed by X-ray diffraction (XRD) and electron microscopy analysis. Prolonged milling led to significant oxygen pick-up in the powders. The Al-5Mg-0.1Er powders experienced grain growth typical of cryomilled Al-Mg powders, while the Al-5Mg-0.5Er alloy showed improved thermal stability. An average grain size of ~20 nm was observed up to 400°C (~0.8Tm) in the Al-5Mg-0.5Er powders, and abnormal growth at 550°C resulted in a maximum observed grain size of 234 nm. Thermal stability in the Al-Mg-Er powders is attributed to the combined effects of solute/impurity drag and second-phase pinning (nanoscale oxides, nitrides, and oxynitrides) that impede grain boundary motion